Paper 1

NHS GRAMPIAN

Tobacco Control 2020 Action Plan - Summary

  1. What is Tobacco Control?

The national tobacco control strategy Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland (Scottish Government, 2013) aims to create a tobacco-free generation through:

  • Prevention – creating an environment where young people choose not to smoke
  • Protection – protecting people from second-hand smoke
  • Cessation – helping people to quit smoking.

Tackling the clear variation in levels of smoking between different parts of our society remains an important theme.

The NHS Grampian Tobacco Control 2020 Action Plan, developed with our Community Planning Partners, sets out local action to implement the national strategy. In addition to tackling the three themes above, the plan also outlines a number of supporting actions which can be grouped as follows:

  • integration and partnership working
  • workforce education and training
  • patient and public involvement
  • knowledge and evidence.
  1. Why is Tobacco Control important?

Smoking is the most important cause of preventable ill health and premature death in Scotland and Grampian. Every year, tobacco use is associated with over 1000 deaths in Grampian and nearly 5000 hospital admissions. Tobacco-related illness is estimated to cost NHS Grampian £30 - 46.6 million per annum.

Tobacco control is therefore central to the Healthfit 2020 aim of supporting our population to live longer,healthier lives.

  1. Where are we now?

In Scotland, the introduction of the smoking ban in public places in 2006 delivered demonstrable improvements for health with cleaner air, a reduction in heart attacks, and reduced second-hand smoke exposure in children, non-smokers and among staff in high tobacco-smoke exposure workplaces.

Compared to ten years ago in Grampian:

  • The number of adults who smoke has reduced significantly from 27% in 1999/2000, to 21% in 2009/2010 (Scottish Household Survey).
  • Regular smoking among 13 and 15 year olds in Grampian also reduced between 2002-10 from 7% to 2% in 13 year olds and from 24 % to 13% in 15 year olds (Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS))
  • Fewer pregnant women than ever report they smoke and the gap in smoking prevalence between the most and least deprived pregnant mothers has narrowed.

However, we cannot be complacent because:

  • Smoking is a key contributory factor to health inequalities in life expectancy between the richest and poorest in our communities. Heavy smoking is 4 times more likely in the most deprived communities compared with our most affluent communities.
  • Smoking in pregnancy in the most deprived areas is considerably more common than in the least deprived i.e. 42% and 9% respectively.

Tobacco control is therefore a key aspect of our efforts to reduce health inequalities.

  1. What needs to be done?

NHS Grampian has two key roles in the tobacco control agenda:

  • To provide local leadership to create a smoke-free generation.
  • To become a smoke-free NHS.

Proposed action to support:

  • Prevention: Stopping smoking is part of the solution, but avoiding ever starting smoking is equally important in the long term. Children from families where there is smoking are more likely to smoke and to have a lifelong addiction to smoking.

NHS Grampian staff working with families should be supported to ensure exposure to smoke and smoking behaviour in childhood is reduced. A number of actions are underway or in development, including a policy development in youth settings, the Smoke Free Homes and Cars initiative and training programmes in behaviour change for those staff working with families or young people.

  • Protection: A considerable component of the NHS Grampian plan is protection, working with communities and organisations across Grampian. NHS Grampian, as an exemplar organisation,is currently reviewing its own Tobacco Policy. All NHS sites must become smoke-free no later than March 2015. NHS Grampian promotes tobacco control through its links with other organisations, either through Healthy Working Lives or through more formal links with organisations such asits three Local Authority partners.
  • Cessation: The National Institute for Health and Clinical Excellence (NICE) ranksevidence-based smoking cessation support as one of the most cost-effective interventions that is available to the NHS. NHS Grampianaims to provide high quality smoking cessation support to all those who wish to stop smoking (two thirds of Scottish smokers say they would like to quit).

Tailored services will be made available to target groups such as deprived communities, pregnant mothers, and patients in our healthcare facilities.

The NHS Grampian Smoking Advice Services perform well. These are delivered across a range of settings – community pharmacy, Healthpoints, and specialist cessation services for individuals and groups.

NHS Grampian has consistently exceeded the HEAT targets (4 week quit rates) both for the universal programme and for the inequalities targeted component. Benchmarking against other Scottish Boards indicates we could improve our reach, particularly with pregnant women.

Giving up smoking is the single biggest thing that someone can do to improve their health. The Planned Care Programme Board recently endorsed embedding smoking cessation in all care pathways. Initial work for smoking cessationwill focus on the maternity care pathway and pre-operation surgical services pathway:

The Maternity Care Quality Improvement Collaborative aims to refer 90% of women who have raised Carbon Monoxide levels or who are smokers to smoking cessation services and to provide a tailored package of care to all women who continue to smoke during pregnancy. Work is underway in Grampian using improvement methodologies and patient engagement to improve our smoking cessation services for women.

Pre-operative smoking cessation – Stop Before Your Op.52% of smokers will experience wound complications following an operation compared to only 18% of those who quit smoking prior to their operation. The average length of stay for patients can be reduced by between 0.4-2 days. In Grampian the equivalent (maximum benefit) of six beds per day could be saved if smokers stopped smoking 4-8 weeks prior to surgery.

  1. Making it Happen

There are examples of good tobacco control practice across Grampian and Scotland. Tobacco Control 2020 aims to ensure good practice is implemented systematically across NHS Grampian as an organisation and Grampian as a whole.

A Tobacco Control Strategy Group, under the chairmanship of the Director of Workforce, has been established to oversee and drive the implementation of the action plan. Representatives from the three Local Tobacco Alliances are members of the group. This ensures strong connections to the three Community Planning Partnerships in Grampian. Indicators of success have been agreed and will be reported through NHS Grampian and partner governance structures.

NHS Grampian receives earmarked funding from the Scottish Government to support prevention and smoking cessation activities. It is intended that this funding will remain in place for the next five years to support implementation of the national strategy.

Many of the actions in Tobacco Control 2020 require a fundamental change in the way NHS Grampianworks and delivers services. These changes are essential if NHS Grampian is going to successfully support and deliver this plan.

6.Conclusion

Smoking is the most important preventable cause of ill health and premature death in Grampian. Tobacco Control 2020 sets out a clear framework for NHS Grampian and its partners to take action towards the national goal of a tobacco-free generation. Board support and active leadership is required to ensure successful implementation.

  1. Recommendation

The Board is asked to support and endorsethe ongoing successful implementation of the Tobacco Control 2020 Action Plan.

Background papers/supporting information

  1. Creating a Tobacco-Free Generation: A Tobacco Control Strategy for Scotland, Scottish Government, 2013
  2. Tobacco Control 2020 Action Plan, NHS Grampian 2012
  3. Benefits of Pre-Operative Smoking Cessation in Grampian, May 2013
  4. Director of Public Health Annual Report, NHS Grampian 2012

Executive Leads

Sir Lewis Ritchie Director of Public Health

Dr Annie IngramDirector of Workforce

Ray Watkins, Head of Health Improvement

Derek Petrie, Tobacco Control Coordinator

July 2013

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